Assessing Micturition, sexual function, and endoscopic outcomes one year after Aquablation: a single center prospective study

Introduction Morphological changes in the prostatic urethra and bladder cavity resulting from Aquablation treatment are still unknown. This study aims to assess the safety and efficacy of Aquablation within one-year post-surgery, focusing on both functional and endoscopic outcomes. Methods Prospective enrollment of patients undergoing Aquablation (10/2018–04/2023) included those with baseline International Prostate Symptom Score (IPSS) ≥ 10, prostate volume from 40 to 80 mL, and Qmax ≤ 12 mL/s. Functional outcomes were evaluated at 1, 3, 6, and 12 months using uroflowmetry (Qmax), and dedicated questionnaires. Cystoscopy at three months assessed ablation quality on a Likert scale (1-poor; 5-excellent). Measurements included cavity length post-treatment and preserved prostatic tissue length at the apex. Additional evaluations encompassed veru-montanum preservation, presence of residual fluffy tissue or mucous flaps, ureteral orifices and bladder trigone injuries. Results Out of 109 enrolled patients, one-year follow-up displayed significant improvements in Qmax (+ 103.08%), IPSS (-86.36%), and IPSS-QoL (-80.00%). Aquablation had no impact on erectile function and continence, preserving ejaculation in 96.3%. Of the 106 patients undergoing cystoscopy, prostatic urethra patency was satisfactory to perfect in 96.2%, with a median cavity length of 24 ± 8.2 mm. Residual median lobe was found in 11.3%, without significant impact on micturition outcomes. Positive outcomes included minimal fluffy tissue and mucosal flaps, and well-preserved ureteral meatuses, verumontanum, and bladder trigone. Conclusions Aquablation showed efficacy in solving urinary symptoms with minimal impact on ejaculation up to one year post-surgery. A three-month post-surgery endoscopic evaluation supports its safety, efficacy, and conformity with the ablative planning.